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Personal Details |
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Title:
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Forenames:
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Surname:
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Present Address:
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Daytime Phone No:
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Evening Phone No:
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Mobile Phone No:
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E-mail:
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UK NI number:
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Do you smoke?
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Do you drive? What type of licence do you have?
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Nationality |
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Do you normally live in the UK?
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What is you nationality?
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Do you have a British or EU passport?
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Do you have/need a work permit?
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Do you have need workers registration?
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Is English your first or second language?
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What is your level of spoken English?
(Very Good, good, intermediate, poor)
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Emergency Contact Details |
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Name:
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Relationship:
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Telephone No:
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Work Telephone No:
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What are your plans in the UK? |
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When would you be available to start work for HHUK?
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How long are you able to work as a live-in carer for HHUK?
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| What are you doing at present? |
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Are you a student (in the UK or abroad)?
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Please give details of your current
employment and a brief description
of your current job role
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Work History |
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Please give the dates and details of the jobs you have had over the last 5 years
(All breaks in employment must be
accounted for)
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Education and Training |
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Please give details of all relevant training
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Please give details of the skills and experience you have, which would make you suitable for the post of a live-in carer
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Can you cook English food?
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Declaration of health |
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Do you have any physical or mental health problems which may affect your work?
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How many days have you been absent from work in the last 3 years through sickness?
Please give details
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Have you been treated in hospital during the last 5 years?
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If yes, please give details
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Rehabilitation of offenders
act 1974 |
The nature of the work for which you applying is excluded from the operation of section 4(2) of the Rehabilitation of Offenders Act 1974. You must therefore disclose any convictions, cautions or bind overs that you have. Any information given here will be treated as strictly confidential and will be considered only in relation to the posts which are excluded from the operation of the 1974 Act by the Rehabilitation of Offender Act 1974 (Exemption Order) |
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Do you have any such offences?
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If yes, please give details
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Signed
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Date
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References |
Please give the names and addresses of two referees
whom we may contact. |
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Ref 1 - Name:
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Address:
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Phone No:
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Ref 2 - Name:
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Address:
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Phone No:
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This Position will be subject to a CRB Enhanced Disclosure, continuous
5 year work history and 2 satisfactory references
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Press submit to proceed to next section,
once this section is completed.
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